Head in the Game: Concussion in Sport

High-profile cases of concussion in various sports recently have shone the spotlight on the issue once more. Shane Hannon explores the history of head trauma on the field of play and in the ring, and outlines why the matter needs to be taken more seriously.

There are many sporting pursuits that by their very nature afford a high risk of concussion – American football, rugby, boxing, cycling, skiing, ice hockey, soccer and equestrian sports to name just some. It is well-known that there are long-term cognitive, psychiatric and neuro-behavioural problems associated with concussion, however the frequency and extent of the problem is far less readily discussed.

According to a report in the Clinical Journal of Sport Medicine, almost half of all rugby players under the age of 20 have at some stage sustained a concussion. It is also now the third most common match injury in amateur and professional rugby, and recent instances of concussion in the RBS Six Nations have highlighted the gravity of the situation. The Welsh medical team were criticised following a recent game after failing to spot and act upon two incidents wherein wing George North was knocked unconscious but allowed to play on. Separate affairs involving England full-back Mike Brown and Irish flanker Sean O’Brien ensured concussion has remained a worrying mention in many column inches.

The key problem seems to be the mind-set of those in rugby and other sports towards concussion, and a seeming nonchalant attitude regarding head trauma. The aforementioned report noted that “Attempts to stem this epidemic, including the wearing of headgear in rugby… have made no difference to the incidence. The key problem is that, until now, concussion has not always been taken seriously enough by players, coaches, and medical staff.” The description of concussion as an epidemic is paramount to this report and a defining yet logical conclusion, given the statistics. An RFU audit recently observed that reported rates of concussion were 59% higher during the 2013/14 Aviva Premiership season than in the previous year – data that equated to 10.5 concussions for every 1000 player hours. In December Johnny Sexton’s club, Racing Metro, revealed that the Irishman had suffered four concussions in 2014 alone.

Dublin GAA star and Acquired Brain Injury Ireland (ABI) Ambassador Rory O’Carroll, who himself was concussed during the 2013 All-Ireland SFC Final against Mayo, stated of late that “While the medical care provided may be of a higher standard and more accessible for professionals, damage to the brain does not discriminate.” He cited Rory Best’s return to the Irish team just 7 days after sustaining concussion in Ireland’s Six Nations victory over Italy in Rome, something which would seem to contradict the IRFU’s official concussion guidelines. These state that an adult’s minimum rest is 14 days, followed by 6 days “graduated return to play protocols.” This also repudiates the stance set out by the Health Service Executive (HSE), who, when contacted for comment, declared that their advice following a concussion is to “… not play contact sport (for example, rugby or football) for three weeks without talking to your doctor first.”

Damage to the brain also refuses to discriminate in terms of the sport, and it is certainly not just rugby that has seen high-profile instances of concussion. Germany’s Christoph Kramer was substituted during the first-half of last summer’s World Cup final in Brazil after appearing dazed and confused after suffering a head injury. Tottenham Hotspur goalkeeper Hugo Lloris played on after suffering concussion following a collision with Everton striker Romelu Lukaku last season in an incident that highlighted the persistent problem in the sport in general, and English soccer in particular, with regards dealing with head injuries. New Premier League rules introduced for this season say that a player suffering a head injury must now leave the pitch and the club doctor must decide if a player is capable of continuing, not team management.

Chronic traumatic encephalopathy (CTE) is a progressive degeneration of the brain caused by repeated head trauma, and the symptoms include memory loss, rage and mood swings, and depression. It can only be definitively diagnosed after death, although some scientists think it will be feasible to test the living for it within ten years. It is a brain condition normally linked to boxing, but a coroner ruled that the death of West Bromwich Albion legend Jeff Astle in 2002, aged just 54, was directly linked to a long career of heading heavy leather footballs. Astle scored an impressive 174 goals in 361 appearances for The Baggies, but he paid a price for his success and long career in the game. Astle’s daughter Dawn has confirmed that “The coroner ruled industrial disease, dad’s job had killed him and in any other profession that would have had earthquake-like repercussions, but not football. It was like [The FA] were trying to wriggle out of it and that’s wrong.” The Justice for Jeff campaign was launched in 2014, with the aim of initiating an independent inquiry into a possible link between degenerative brain diseases and heading footballs.

American football and in particular the National Football League (NFL) have come under close scrutiny because of the effects concussion has on the lives of its players. In 2013 the NFL reached a $765 million settlement with former players who said it hid the dangers of concussion. The money was directed towards the fund of concussion-related compensation, medical exams and research, while a released NFL Concussion Statement announced the providing of three benefits:

Lawyers also recently announced that another settlement, this time worth $1 billion, is nearing approval. This settlement will compensate players for head injuries suffered during their careers and is expected to cover about 20,000 now-retired NFL players over the next 65 years.

Settlements like this have already come too late for other NFL players however. Illustrious San Diego Chargers linebacker Junior Seau committed suicide in May 2012 aged 43 and later studies by the National Institutes of Health (NIH) found that he had suffered from CTE, a condition that has been discovered in many other NFL players. The findings on Seau were said to be similar to autopsies of people “with exposure to repetitive head injuries.” This tragic death followed the 2011 suicide of veteran Chicago Bears, New York Giants and Phoenix Cardinals safety Dave Duerson, who sent a text to his family before he fatally shot himself specifying that he wanted his brain to be used for research. It was found that he too had suffered from chronic traumatic encephalopathy or CTE, undoubtedly caused by persistent blows to the head during a long career in American Football.

Super Bowl champion Sidney Rice, formerly of the Seattle Seahawks, was in the headlines recently alongside New York Giants punter Steve Weatherford when they both announced they planned to donate their brains to science research after they die. Rice, who suffered 8-10 concussions throughout his career, hung up his cleats last July at the tender age of 27, citing concussion concerns having viewed an ESPN documentary about the demise of former NFL players Tony Dorsett and Hershel Walker.

Concussion isn’t merely a problem for those engaged in ball sports, with two-time Formula One champion Fernando Alonso suffering head trauma and concussion in a test crash last month. Spaniard Alonso hit a wall at the demanding Turn Three corner at the Circuit de Barcelona – Catalunya whilst travelling at 134 miles per hour, suffering temporary memory loss. According to reports in Le Pais newspaper, Alonso thought it was 1995, telling doctors “I’m Fernando, I race karts and want to become a Formula One driver.” McLaren’s racing director Éric Boullier has been quick to refute these claims however, asserting that “It’s not as dramatic as you read in the media. Everything is back to normal.” Alonso’s fellow Formula One champion Michael Schumacher suffered a much-publicised traumatic brain injury in December 2013 while skiing in the French Alps, with his doctors opining that without his helmet he would have been killed instantly. As of November 2014 it was reported that Schumacher was “paralyzed and in a wheelchair” and that he “cannot speak and has memory problems.”

Boxing is perhaps the most obvious sport to be affected by concussion to its athletes and, according to the American Association of Neurological Surgeons, nearly 90% of boxers will suffer from a brain injury at some point, with the wearing of headgear greatly reducing the frequency and seriousness of injuries sustained. Dementia pugilistica (DP) is a variant of CTE and a neurodegenerative disease with features of dementia that most commonly affects boxers and wrestlers and those engaging in sports that can lead to concussion. It is thought to affect 15%-20% of professional boxers, with an average time of onset of between 12 and 16 years after the start of one’s boxing career.

An April 1983 Sports Illustrated article entitled “Too Many Punches, Too Little Concern” pointed out that the most common characteristics of boxers suffering outward signs of dementia were enlarged brain ventricles and a cavum septi pellucidi. The article also cites the results of CT scans on 8 former boxing champions, with 5 displaying firm evidence of the signs of dementia noted above. Two of those were the boxing great Muhammad Ali (who was diagnosed with Parkinson’s disease the following year, common to head trauma) and Jerry Quarry (who died of dementia pugilistica 16 years later aged 53 in 1999.)

It is evident that the problem is gaining too much traction to be ignored any longer, in any sport. The long-term effects of head traumas are plain to see, and the HSE went on to tell me that “Most people recover quickly from their accident and experience no long-term problems. However, some people only develop problems after a few weeks or months.” The benefits need to be weighed up against the risks, and yet for many professional athletes the lure of good money, silverware and fame eclipse the fear of long-term damage to their bodies.

There is life after sport, but without significant action and further education on the dangers of concussion, the quality of life for sporting retirees will simply diminish. It’s now or never, and for many now is already too late.

For more information on Acquired Brain Injury Ireland (ABI) visit their website at http://www.abiireland.ie/

For more information on the Justice for Jeff Astle campaign see the Facebook page at https://www.facebook.com/justiceforjeffastle